Therapy associated changes in cerebral representation of craniomandibular dysfunction.

颅下颌功能障碍（CMD）的治疗方法的作用方式是广泛未知的。对颞下颌关节水平的研究不能清楚地区分病理与无CMD参与者的数据。虽然它是已知的，心理因素在慢性疼痛的发生有重要作用，这些因素的神经生物学基础是广泛未知的。我们的研究小组已经确定了下颌运动功能表征的基础知识，并证明了CMD患者咬合运动的大脑表征特征。使用功能性磁共振成像（fMRI）在纵向设计，我们证明了如何在CMD患者的咬合运动的代表性改变了三个星期的治疗与密歇根夹板。作为治疗过程中情感变化的功能相关，我们确定了前额叶。与其他区域一起，该区域已被报道显示出通常与慢性疼痛相关的特征性功能和结构变化。在计划的研究项目中，我们调查了咬合接触相关夹板（密歇根型）的具体效果。我们将通过比较治疗期间临床（例如疼痛强度）和神经生理学（例如咬合功能表示）参数的变化与等待组设计中不影响咬合接触的夹板（腭夹板）的变化来实现这一点。通过测量治疗前后咬合的功能表征以及咬合的其他参数（咬合运动的对称性;颞下颌肌肉组织在休息和最大咬合时的活动），我们将能够识别与治疗相关的功能表征变化的特定方面。我们在这里评估的局部变化的代表，但也在网络的区域处理运动控制和疼痛感知的变化。此外，这些患者的功能表征的初始变化以及情绪消退期间行为和功能表征的改变将与对照组进行比较。因此，我们将增加洞察这些患者的情感处理方面的交替。通过更好地了解夹板治疗对颅下颌疼痛和相关情感成分的处理的具体效果，我们打算提高这些治疗的效率。

The mode of action of therapy approaches for craniomandibular dysfunction (CMD) is widely unknown. Research on the level of the temporomandibular jaw could not clearly differentiate pathology from the data of participants without CMD. Although it is known that psychological factors have an important role in the genesis of chronic pain, neurobiological basics of these factors are widely unknown. Our group already identified basics of functional representation of jaw movements and demonstrated characteristics of cerebral representation of occlusal movements in patients with CMD. Using functional magnetic resonance imaging (fMRI) in a longitudinal design, we demonstrated how the representation of occlusal movements in CMD patients were altered during a three week therapy with a Michigan splint. As a functional correlate of affective changes during therapy we identified the anterior insula. Together with other regions, this area has been already reported to show characteristic functional and structural changes generally associated with chronic pain. In the planned research project we investigate the specific effect of an occlusal contact relevant splint (Michigan type). We will do that by comparing changes on clinical (e.g. pain intensity) and neurophysiological (e.g. functional representation of occlusion) parameters over therapy with those of a splint not affecting the occlusal contact (palatine splint) in a waiting group design. By measurement of functional representation of the occlusion before and after therapy in addition to other parameters of occlusion (symmetry of occlusal movements; activity of the temporomandibular jaw musculature at rest and maximal occlusion) we will be able to identify specific aspects of functional representational changes associated with therapy. We here do evaluate local changes of representation but also changes in the network of regions processing movement control and pain perception. In addition, initial changes in functional representation in these patients and altered behavior and functional representation during emotional extinction will be compared with a matched group of control subjects. Hereby, we will increase insight in the alternations of these patients with respect to affective processing. By a better understanding of the specific effect of splint therapy on the processing of craniomandibular pain and associated affective components we intend to increase the efficiency of these therapies.